Excerpts
BETTY ANN BOWSER (Newshour): On the outside, 58-year-old Carolyn Eaton looks like the picture of health. She eats right and keeps in shape by taking daily walks with her dog Mischa near her apartment in Northern Virginia.
But, on the inside, Eaton is fighting a serious heart condition called cardiomyopathy that weakens her heart. Equally important, it also makes her uninsurable.
CAROLYN EATON, uninsured: It's frightening right now because my health is pretty stabilized. The only thing that I'm worried about is if I have a catastrophic event. What if I have a heart attack?
I really love this picture of Trey.
BETTY ANN BOWSER: Eaton has had no health insurance since last fall because of her preexisting condition.
The federal government estimates that hundreds of thousands of Americans share her dilemma and are denied insurance coverage because of health problems. Bush, starting this summer, they will be able to apply for temporary coverage through the preexisting insurance plan. It's part of the new health care reform law passed in March.
The plan is designed to provide coverage until 2014. That's when the broader rules that will forbid insurance companies from denying coverage to all individuals with health problems kick in.
Richard Popper heads the new program for the Department of Health and Human Services.
RICHARD POPPER, Office of Consumer Information and Insurance Oversight, Department of Health and Human Services: The preexisting condition insurance plan is designed to provide immediate coverage, access to coverage for people who are locked out of the insurance market.
BETTY ANN BOWSER: Popper, who ran the Maryland state high-risk pool before he took his post at HHS, estimates as many as 400,000 Americans may enroll in the new federally funded program.
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BETTY ANN BOWSER: Twenty-nine states and the District of Columbia will run their own high-risk programs using their share of a $5 billion federal pool of money set aside. Twenty-one others have opted out. In those states, HHS will run the pools through a third-party administrator.
To qualify, applicants must be an American citizen, have been denied coverage by an insurer because of a medical condition, and be uninsured for at least six months.
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BETTY ANN BOWSER: People who sign up can be charged no more than what healthy people pay for insurance coverage in their state. But the federal government will pay the difference between that and the actual cost of the premiums. Dollar amounts will vary from state to state.
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BETTY ANN BOWSER: Running out of money from the federal government is the main reason most states have given for opting out of the high-risk program. So, under the new law, it's now up to the Department of Health and Human Services here in Washington to develop coverage for people who live in those states and are hard to insure.
Even the nonpartisan Congressional Budget Office reported recently that the funding available for subsidies wouldn't be sufficient to cover the costs of all applicants through 2013. And the CBO predicted HHS would have to use its authority under the law to limit enrollment in the program.
Popper says he thinks the $5 billion is adequate.
RICHARD POPPER: We have ways of managing that money to make it last. We can adjust some of the cost-sharing. We can shift money between the states, because, in some states, you could have very dramatic enrollment growth, in other states, not so dramatic, because of the nature of their marketplace. And we can also take a look at the way the premiums are calculated.
BETTY ANN BOWSER: But the premiums, even with the federal government paying a substantial part of the cost, may be too high for some people to afford. HHS estimates premiums will run between $140 and $900 a month.
Deborah Chollet is a health insurance expert and senior policy fellow at Mathematica Policy Research in Washington. She says who will be able to afford the program is a big unanswered question.
DEBORAH CHOLLET, senior policy fellow, Mathematica Policy Research: There's really no good way to know. I think when people apply to the high-risk pool, even though it will be subsidized substantially, even though it is unique, and that the premiums will be at market rates for healthy people, I think they will still be amazed at how expensive it is.
BETTY ANN BOWSER: But HHS's Popper says the program is designed to be a temporary one.
RICHARD POPPER: It's not a solution for everyone, because there are still a lot of issues and challenges in the insurance marketplace, but it's designed to be a bridge until 2014, when the more significant and larger health reforms take effect.
This is better than nothing but this plan is not perfect.
We are in this bind because the insurance marketplace puts a dollar value on YOUR health and does NOT care if you can afford it or not. This highlights a flaw in on our free-market economic philosophy that puts a dollar value to people's health vs paying whatever it takes to keep you healthy. Our free-market MAY be the best (for us at least) but it is NOT fault-free, like ANYTHING humans design.
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